Wed March 26, 2014

Fewer People Are Getting Infections In Hospitals, But Many Still Die

Hospital-acquired infections continue to be a big problem in health care, with 4 percent of patients getting a new infection while hospitalized, a study finds. And 11 percent of those infections turn deadly.

It's the first time that the Centers for Disease Control and Prevention has attempted to catalog all hospital infections, not just the infections with germs on their watch list. Researchers surveyed 183 hospitals nationwide, emphasizing smaller community hospitals.

"Although there has been some progress, today and every day, more than 200 Americans with health care-associated infections will die during their hospital stay," said the CDC's director, Dr. Tom Frieden. That translates to more than 70,000 deaths a year caused by hospital infections.

The finding suggests that hospitals could reduce their pneumonia rates by doing more to prevent patients from inhaling food particles, a known cause of the lung ailment. So there are clues in this study that can improve treatment.

But the overall numbers show there's still a long way to go. The 2011 survey, published Wednesday in the New England Journal of Medicine, found that 4 percent of people hospitalized picked up an infection, and of those, about 11 percent died.

"One of the most common things affecting patients in the survey was pneumonia," says Dr. Michael Bell, deputy director of the division of health care quality promotion at the CDC. The centers had already been tracking pneumonias that occur in people who are on mechanical ventilators. But, it turns out, "a good proportion of it was pneumonias in patients who were not in the intensive care unit."

Some gains have been made in certain procedures, Bell says — for example, when physicians or nurses insert a catheter tube.

"By doing things right when you put the catheter in," he says, "we can drive down infection rates because of those catheters by 70 percent."

But those specific improvements still leave hospital patients at significant risk.

"It's sobering to realize that despite all those efforts we still have this level of problem," says Dr. Brad Spellberg at the Harbor-UCLA Medical Center. And it won't be an easy fix, he says. "If we depend on changing human behavior as the only implementation tool to prevent infections, we're going to plateau."

Instead, Spellberg argues we need new germ-killing technology, including new vaccines that target common hospital infections.

"We need to be much better as a health care delivery system in this country at preventing hospital admissions and getting people out of hospitals much faster," Spellberg says, "because if you're not in the hospital, you won't get a health care-associated infection."

He congratulates the CDC for finally finding the money to do a broad survey like this. But Europe, he notes, conducts this kind of survey on an ongoing basis. Patients, as well as health care researchers, can go online any time to see annual statistics for hospital infections. He says that's what we need in the United States.

Meanwhile, Americans can get some information about infection rates at specific hospitals via this Medicare site. Select a particular hospital and then click on the tab that says "Readmission, complications & deaths." Click on "Healthcare-associated infections" for basic information, and on the "Show Graphs" button for further details.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

A national survey finds that one out of every 25 people in the hospital gets a new infection during their stay. The study, by the Centers for Disease Control and Prevention, says that in 2011 about 650,000 people got infected while in the hospital. About 10 percent of those people died.

NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE: You go to the hospital to get better. But, of course, medical care always carries some risks.

DR. MICHAEL BELL: Unfortunately, we're painfully aware of the fact that people do get infections in healthcare settings

HARRIS: Dr. Michael Bell of the CDC says his organization tracks the worst of those infections. But the CDC wanted to find out if it was missing anything by focusing on infections they already knew were bad actors. So they surveyed 183 hospitals across the country in 2011 to evaluate the risk of all sorts of hospital infections, not just the ones on their watch list.

BELL: One of the most common things affecting patients that were in the survey was pneumonia. That includes the kind of pneumonia that we've been tracking, the pneumonia that happens to people on mechanical ventilators. But also a good proportion of it was pneumonias in patients who were not in the intensive care unit.

HARRIS: Bell says hospitals can likely reduce their pneumonia rates by simple things, like making sure people sit up in bed more. So there are clues in this study that can guide future improvements. But the overall numbers are also notable. The study found that one in 25 people in the hospital ended up with an infection.

BELL: If we compare that to the previous estimate, that was one in 20. So we're doing a little bit better there. But the fact that 10 percent of people with infections will die during that hospital stay is a very concerning number, and it points at the fact that these are often very ill individuals.

HARRIS: That's about 70,000 deaths among people who picked up an infection in the hospital each year. The report is published in the New England Journal of Medicine. There has been some improvement over the years. Consider central-line catheters, plastic tubes that are inserted into a major blood vessel.

BELL: By doing things right when you put the catheter in, we can drive down infection rates because of those catheters by 70 percent - seven, zero.

HARRIS: But, overall, the figures have not dropped so dramatically. A potentially deadly gut infection called C difficile remains a stubborn problem. So do staph infections and urinary tract infections caused by catheters.

DR. BRAD SPELLBERG: It's sobering to realize that despite all those efforts we still have this staggering level of problem.

HARRIS: Dr. Brad Spellberg studies hospital infections at the Harbor-UCLA Medical Center. He says it won't be easy to fix this problem.

SPELLBERG: If we depend on changing human behavior as the only implementation tool to prevent infections, we're going to plateau.

SPELLBERG: We need to be much better, as a health care delivery system in this country, at preventing hospital admissions and getting people out of hospitals much faster because if you're not in the hospital, you don't get a health-care associated infection.

HARRIS: Spellberg says it's great that CDC finally came up with the money in its tight budget to do a broad survey like this. But he notes that Europe does this kind of survey every year. Patients as well as health-care researchers can go online any time to see how hospital infections are trending. He says that's what we need in the United States. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.